Use of a Tentorial Sling for Microvascular Decompression of the Trigeminal Nerve in Patients with Trigeminal Neuralgia: A Novel Operative Technique and Report of Clinical Outcomes

Abstract

Intro: Trigeminal neuralgia is a debilitating pain disorder characterized by excruciating facial pain. Although atypical forms exist, classic trigeminal neuralgia is caused by arterial compression of the trigeminal nerve at the nerve root entry zone. Microvascular decompression (MVD) remains the most definitive treatment for the disease, with reported cure rates between 60–80% at five years. Traditional decompression methods involve a standard retrosigmoid craniotomy with placement of an inert foreign material (e.g., Teflon, Avalon sponge) between the nerve and compressive vessel. For some patients, recurrence of trigeminal neuralgia after MVD has been associated with migration of arterial vessel back against the nerve, adhesion formation around the nerve, or arterial pulsation against the Teflon abutting the nerve. Additionally, foreign materials may cause inflammatory responses that can trigger delayed recurrence of trigeminal pain. Although Teflon is considered an inert material, it has been associated with granuloma formation in 1–7% of cases in which it is used for microvascular decompression.